My Friend, Catherine

Pardon me while I talk to my friend, Catherine. I have to do it here because she does not allow comments on her blog, and there's something I really, really want to say to her.

Dear Catherine,

Please go talk to someone in real life. Please. Can you get a medical leave of absence from the school? If not, I beg you to call in sick and stop overloading yourself with stress.

You have to do something now. You cannot put it off anymore, and you cannot wait to feel better.

I care about you and your family, and want you to feel better. Please focus on the little one - your daughter is living with a ghost. You owe it to her to take care of yourself. The way she is living now will remain with her the rest of her life, I promise you that. You're a good mother, please don't do that to her.

Email me please, I would be happy to talk with you any time you want someone to talk to.

Nothing but love,
Connie

Juvenile Bipolar Research Foundation Newsflash

Newsflash #1
Research Progress: A New Approach

This is the first of a three-part series created to familiarize you with some exciting and hopeful information regarding our research on juvenile bipolar disorder.

In order to get to the end of any journey, you must travel in the correct direction. In terms of understanding juvenile bipolar disorder, the JBRF Research Consortium has taken some impressive steps down the right path.

The prevailing view of psychiatric illness has been that each mental disorder is unique and separate from all other mental disorders. As such, each behavioral symptom belongs solely to one or another of the identified illnesses. This is referred to as a categorical approach because each symptom is assigned to a discreet category. Practically speaking, all the diagnostic, clinical and research work of the last 30 years has used the categorical approach as its foundation. It is important to note that this foundation derives from ideas, not facts, and that the diagnostic categories it created were never intended to be permanent.

Psychiatric diagnoses do not have the benefit of biological evidence like medical diagnoses do. This is not surprising given the fact that our extraordinary brains and all-powerful DNA have, until recently, been pretty much beyond our reach to explore. Lacking biological evidence, ideas were the next best thing.

While the most passionate and well informed people were involved in the development of this approach, times have changed and knowledge has advanced. However, this underlying view has not. Fortunately, geneticists and neuroscientists have started to question the merit of the categorical approach to diagnosis. In fact, some investigators have reached the conclusion that this underlying framework may prove to be a principal obstacle that has led to stagnation of the research in the quest to untangle complex mental illnesses such as bipolar disorder.

“Big deal” you might say. It doesn’t really matter what you call it or how you define it; what really matters is dealing with the individual’s symptoms as they present. But it is a big deal; because the individual will never get relief until we can truly understand the problem. In today’s cutting edge scientific practices, where microscopically small differences and enormously complicated mechanisms are in play, to start from a correct foundation matters.

The perspective that has emerged is that we need to study mental illnesses from the view that there is an inevitable overlap of symptoms between psychiatric conditions as they are now defined. What may distinguish one condition from the other is how those clusters of overlapping symptoms come together. This is called the dimensional approach to defining psychiatric disorders. Once this “new”, more diverse profile of symptoms is established, the next step in the research process is to refine the profile in order to be able to link it to a specific biological source.

This dimensional approach is what the investigators of the JBRF Research Consortium have adopted. Proceeding down this path, researchers have arrived at a novel description of juvenile bipolar disorder that describes more directly and accurately the symptoms these children actually experience. This new perspective has quickly led to a model of the underlying biology that may help to explain this illness at a more fundamental level. It has opened up new research priorities and treatment opportunities. This view has led to the identification of a potential biomarker (measurable biological indicator) of the illness. Its accuracy makes the chances for meaningful genetic studies much more likely.

If you want to jump ahead and learn more about the work we are accomplishing, there is a link at the end of this piece to a summary where you can read more about it. In the second part of this series, we will describe this profile in more detail and in the third part we will tell you what we are trying to do with this information. We have no answers that will turn your life around today. But we are confident that we are on the right path to provide those answers tomorrow.


NewsFlash #2
Characteristics of Juvenile Bipolar Disorder: A New Phenotype

This is the second of a three-part series to inform you about JBRF sponsored research on juvenile bipolar disorder. We hope you will be encouraged by our progress and inspired to believe that the end of this journey is attainable. Please click HERE to refer to the first News Flash.

What do the following have in common?

* suffers horrendous nightmares
* antagonizes siblings
* excessively craves sweets and carbohydrates
* wets the bed
* sleeps hot
* takes excessive risks
* hoards food
* has many ideas at once
* interrupts or intrudes on others
* experiences periods of self-doubt and poor self-esteem
* deflects blame

Independently, each of these traits is a symptom of a myriad of different psychiatric disorders. Considered together, they are all symptoms of Pediatric Bipolar Disorder (PBD).

But wait a minute! Isn’t bipolar disorder all about mania and depression? How can these unrelated symptoms be part of that same profile?

This more complete list of symptoms is reflective of the research progress JBRF has made by adopting the dimensional approach of defining psychiatric disorders: symptoms overlap between psychiatric conditions and one condition is differentiated from the other by how those clusters of overlapping symptoms come together.

Proceeding down this path, researchers have arrived at a novel perspective of the illness. While traits like mania and depression remain important, this analysis finds that they are not the central behavioral dimensions of PBD. Other dimensions such as aggression, anxiety, sensory sensitivity, sleep/wake disturbance, attention/executive function deficit, and oppositional behavior also figure prominently. Of paramount interest is a dimension that establishes a link between obsessive fears and aggressive behavior. JBRF investigators have termed this correlation “Fear-of-Harm” (FOH). This new characterization of PBD has been labeled the “Core phenotype”.

The Core phenotype is a more complete and accurate description of what these children experience than what is offered by the Diagnostic and Statistical Manual for Mental Disorders (DSM). Investigators suggest that in the DSM, bits and pieces of this single disorder have been parceled out into numerous other diagnoses. It is likely that this fragmented perspective of the disorder has obscured a clear view of its actual presentation in children and stalled efforts to get at the underlying biology.

Concentrated exploration of the FOH trait has lead investigators to define a clinically homogeneous subgroup of children who are the most severely impacted by this disorder. This subgroup is called the “FOH phenotype”. These children are characterized by extreme anxiety and the hyper-perception of threat which causes them to respond in a defensively retaliatory manner. They are often hospitalized and face great challenges socially and academically.

Not only have JBRF investigators been able to describe the symptom profile of the FOH phenotype, but under this new paradigm, they have also pieced together the likely underlying biology involved in the disorder. Certain brain areas, activities and development that had not previously been considered became obvious foci for their attention. The specific neural pathway that ties these activities together in a manner consistent with the profile has been identified. Investigation of this complex system is ongoing. The more the details fall into place, the greater its explanatory value grows.

The definition of the FOH phenotype moves us further in our quest to uncover the genetic variations associated with PBD. The high heritability of the FOH trait, refinement of the dimensionally derived symptoms that associate with it, and the fact that the CBQ can identify with 96% accuracy children whose profiles fit the phenotype make us optimistic that we are on the right path for a meaningful genetic analysis.

JBRF is actively collecting DNA from children whose CBQ scores indicate that they fit the FOH Phenotype.

This novel understanding of the dimensions of bipolar disorder in childhood puts us on much firmer footing as we move towards the identification of biological markers. The identification of new biological markers opens the door for new treatments.

Source.

Good News, Brad News

Excellent interview with Brad from ArjanWrites.com

SUPERFRAICHE: Arjan chats with Brad Walsh from Arjan Writes on Vimeo.

Source